Under the agreement, a London Health Board will be created to have political oversight and stewardship of health services in London, which will be headed up by the Mayor of London.

But, like in Manchester, the LMC has not been involved in initial talks around devolving powers.

Although the agreement does not spell out specific plans for GP services, it does mention moving towards the ’new models of care’ described in the NHS Five Year Forward View.

It said this would include Accountable Care Organisations (ACOs) – a model where providers merge to span primary and secondary care.

The agreement, signed today at Great Ormond Street Hospital, will begin with five devolution pilots to be launched across London boroughs and focusing on different topics:

Haringey will run a prevention pilot exploring the use of flexibilities in existing planning and licensing powers to develop new approaches to public health issues.

Barking & Dagenham, Havering and Redbridge will run a pilot to develop an ACO, where primary and secondary care are more closely integrated and patient pathways are redesigned with a focus on intervening early and managing the chronically ill.

North Central London (Barnet, Camden, Enfield, Haringey, Islington) will run an estates pilot to test new approaches to collaboration on asset use.

Lewisham will run a pilot seeking to integrate physical and mental health services alongside social care.

Hackney will run a health and social care integration pilot, aiming for full integration of health and social care budgets and joint provision of services. This will also have a particular focus on prevention.

But Londonwide LMCs chief executive Dr Michelle Drage said GP representatives were not invited to a London devolution panel and did not know how GPs would be affected by the plans.

She said: ‘It is confusing to say the least. My worry is that they are entering London GPs into another round of reorganisation, at the worst possible time. It seems to me to be at odds with reality. Maybe that is why they have left providers out.

‘Because it seems they are just talking to each another as commissioners. When we understand the proposals, we will expect them to talk to us.’

Asked whether, like in Manchester, the LMCs would push for inclusion on the devolution panel, she said: ‘It depends. Devolution will only work if it is based on sound principles, which align with what the issues are on the ground.

‘From what I’ve seen so far, it doesn’t matter if we are on the panel or not, and it is not clear whether it would be a help or a hindrance. I’d much rather see the problems we do have addressed than talk about organisational change, which looks like just moving around the deckchairs.

‘The fact is that we have not been invited.’

Mayor of London Boris Johnson said: ‘As we’ve shown through transport, policing and planning, devolution is already working in London and this agreement paves the way for a revolution in how health and social care are delivered across the capital. With our city’s population continuing to grow, it is essential that we have a health service better equipped to manage its own resources so that it can become even more responsive to the needs of Londoners.’

All this if funding is equitable. But it is not. Some practices earn 500 pounds, others 100 pound per patient year. Even disregarding such extremes, there is variability of a factor of 2 in neighboring practices.These new projects will have unfair and unjust levels of funding compared to others.Some hospitals in London have 125 consultants compared to Nottingham with 50 consultants for 100 beds.London average spending per patient 526 compared to Lancashire 186.A+E consultant ratios vary from 1 for 5000 to 1 for 200000 patients.The NHS is riven, riddled, saturated with injustice and discrimination.Yet the poorest practices are compared as equal with the richest by CQC [ for example ] and castigated and shamed , a case of insult added to injury.Their response when this discrimination was pointed out was ' we are not responsible for funding'So, these new schemes have to succeed. They will be well heeled compared to some other poor sods.